Provider Demographics
NPI:1578914735
Name:TUPUOLA, JULIETTA
Entity Type:Individual
Prefix:
First Name:JULIETTA
Middle Name:
Last Name:TUPUOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8627 JUNIPER ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90002-1539
Mailing Address - Country:US
Mailing Address - Phone:323-537-8979
Mailing Address - Fax:213-389-7993
Practice Address - Street 1:1730 W OLYMPIC BLVD # 3A-300
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-1019
Practice Address - Country:US
Practice Address - Phone:213-249-9388
Practice Address - Fax:213-389-7993
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator